Gupta Pulin K, Gupta Manu, Lal Ashok K, Taneja Anil, Taneja Rajesh S, Rewari Bharat B
Department of Medicine, Postgraduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, New Delhi, India.
Department of Radiology, Postgraduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, New Delhi, India.
J Virus Erad. 2018 Jan 1;4(1):21-25. doi: 10.1016/S2055-6640(20)30237-5.
Wider access to antiretroviral treatment (ART) has resulted in a decline in the number of people dying due to AIDS-related causes. However, with this increased longevity, accelerated rates of cardiovascular and atherosclerotic diseases are on the rise. We hypothesised that the prevalence of atherosclerotic cardiovascular diseases is greater in HIV/AIDS patients as compared to the normal population. Thus, we aimed to study the predictors of subclinical atherosclerotic disease in HIV-infected individuals.
In total, 168 HIV-positive individuals below 45 years of age (124 [73.08%] on ART and 44 [26.2%] ART naive) along with 150 age- and sex-matched healthy controls were recruited for this cross-sectional observational study. Carotid intimal medial thickness (cIMT), a surrogate marker of atherosclerosis, was assessed by a carotid colour doppler ultrasound and a mean of four measurements (both sides) were taken. cIMT was correlated with the age of the individuals, duration and type of ART, duration of disease and the level of immunodeficiency (CD4 cell count) along with conventional cardiac risk markers.
In 168 HIV-positive individuals, the mean CD4 cell count was 332.41 ±17.1 cells/mm. The mean cIMT of all HIV-positive individuals was 0.712 ±0.039 mm (0.596-0.840 mm) as compared to 0.616 ±0.023 mm (0.540-0.655 mm) in HIV-negative individuals (<0.001). cIMT in HIV-positive individuals on ART (subgroup A) was 0.723 ±0.034 mm as compared to 0.682 ±0.038 mm in HIV-positive individuals not on ART (subgroup B) (<0.01). Low CD4 cell counts, longer duration of HIV infection, exposure to ART and longer duration of ART were found to be independent predictors of a higher cIMT in HIV-positive subjects whereas age, diastolic blood pressure, low HDL, smoking and high BMI were predictors of high cIMT in HIV-negative controls. No difference was observed in cIMT among patients on different ART regimens but individuals who were on nevirapine had higher cIMT as compared to those who were on efavirenz, both non-nucleoside reverse transcriptase inhibitors (NNRTIs).
Individuals with HIV infection (whether on ART or ART naive) have higher cIMT, and therefore a higher atherosclerotic burden, as compared to HIV-negative individuals. HIV infection itself, along with ART, overshadows conventional cardiac risk markers as a predictor of atherosclerotic disease in these individuals.
更广泛地获得抗逆转录病毒治疗（ART）已导致因艾滋病相关原因死亡的人数下降。然而，随着寿命的延长，心血管疾病和动脉粥样硬化疾病的加速发病率正在上升。我们假设，与正常人群相比，艾滋病毒/艾滋病患者中动脉粥样硬化性心血管疾病的患病率更高。因此，我们旨在研究艾滋病毒感染者亚临床动脉粥样硬化疾病的预测因素。
总共招募了168名45岁以下的艾滋病毒阳性个体（124名[73.08%]正在接受ART治疗，44名[26.2%]未接受过ART治疗）以及150名年龄和性别匹配的健康对照者进行这项横断面观察性研究。通过颈动脉彩色多普勒超声评估颈动脉内膜中层厚度（cIMT），这是动脉粥样硬化的替代标志物，并对四次测量值（双侧）取平均值。cIMT与个体年龄、ART治疗的持续时间和类型、疾病持续时间、免疫缺陷水平（CD4细胞计数）以及传统心脏风险标志物相关。
在168名艾滋病毒阳性个体中，平均CD4细胞计数为332.41±17.1个细胞/mm³。所有艾滋病毒阳性个体的平均cIMT为0.712±0.039mm（0.596 - 0.840mm），而艾滋病毒阴性个体的平均cIMT为0.616±0.023mm（0.540 - 0.655mm）（<0.001）。接受ART治疗的艾滋病毒阳性个体（A组）的cIMT为0.723±0.034mm，未接受ART治疗的艾滋病毒阳性个体（B组）的cIMT为0.682±0.038mm（<0.01）。低CD4细胞计数、更长的艾滋病毒感染持续时间、接受ART治疗以及更长的ART治疗持续时间被发现是艾滋病毒阳性受试者中较高cIMT的独立预测因素，而年龄、舒张压、低高密度脂蛋白、吸烟和高体重指数是艾滋病毒阴性对照者中高cIMT的预测因素。不同ART治疗方案的患者之间cIMT未观察到差异，但与接受依非韦伦治疗的患者相比，接受奈韦拉平治疗的患者cIMT更高，二者均为非核苷类逆转录酶抑制剂（NNRTIs）。
与艾滋病毒阴性个体相比，艾滋病毒感染者（无论是否接受ART治疗）具有更高的cIMT，因此动脉粥样硬化负担更高。在这些个体中，艾滋病毒感染本身以及ART治疗作为动脉粥样硬化疾病的预测因素，掩盖了传统心脏风险标志物。
